Medication is NOT first line treatment for insomnia.
Clinical Guidelines by the AASM state that Psychological and Behavioral treatments for insomnia are effective and recommended as first line treatment for insomnia (primary and secondary). Furthermore, the guidelines state that when a medication is used for insomnia, that it should be done in the setting of behavioral therapy. — Yet frequently when a patient tells there doctor they are having problems sleeping, without asking many other questions a medication is prescribed.
A side note, the guidelines also state Over-the-counter “sleep aids” as well as herbal and nutritional substances are not recommended in the treatment of chronic insomnia due to the relative lack of efficacy and safety data. — Yet, frequently when someone can’t sleep, this is the first thing that is tried.
What is “Behavioral Sleep Medicine”?
The Society of Behavioral Sleep Medicine (SBSM) states: Behavioral Sleep Medicine is the field of clinical practice and scientific inquiry that encompasses: the study of behavioral, psychological, and physiological factors underlying normal and disordered sleep across the life span; and, the development and application of evidence-based behavioral and psychological approaches to the prevention and treatment of sleep disorders and co-existing conditions.
This is a rather complex definition. In English, I view Behavioral Approaches to Sleep in 2 simplistic ways.
(1)Find out what are negative factors that are causing frustration about not sleeping.
(2) Focus on positive associations about restfulness.
Concept: Pavlov’s Dog.
In the 1890’s Ivan Pavlov was studying feeding functions on dogs. In part of his research, he needed to isolate the saliva from dogs. However, a psychological finding was also found. Noticing that the dogs would begin to salivate before eating, he conducted an experiment where he would ring a bell prior to dinner (hence the term dinner bell). Then, there were times that he would ring the bell, not present food to the dogs, yet the dogs still salivated. The dogs had learned to associate the sound of the bell with food. — Similar, there are environmental and behavioral cues that people can learn to associate with either positive associations with sleep/rest or negative associations with frustration/insomnia.
What are some Behavioral approaches to sleeping better?
Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy, relaxation therapy, sleep restriction therapy, or cognitive behavioral therapy for insomnia. Other common therapies include paradoxical intention, hypnosis, and biofeedback therapy.
Although all patients with chronic insomnia should adhere to rules of good sleep hygiene, there is not enough evidence to indicate that sleep hygiene alone is effective in the treatment of chronic insomnia. It should be used in combination with other therapies.
Opinion: Medications have a place for sleep, but without proper diagnosis of the cause of insomnia.
I am not going to talk about sleep aids and hypnotics, that is not the purpose of this website.
Insomnia cures. Insomnia escape. <Video Link>
